Cervical Cancer

Topic Overview

Is this topic for you?

This topic talks about the
testing, diagnosis, and treatment of cervical cancer. For general information
about abnormal Pap test results, see the topic
Abnormal Pap Test.

What is cervical cancer?

Cervical cancer occurs
when abnormal cells on the
cervix grow out of control. The cervix is the lower
part of the uterus that opens into the vagina. Cervical cancer can often be successfully treated when it's found early. It is usually found at a very early stage through
a
Pap test.

Cervical cancer is one of the most common cancers in women worldwide. But in the United States and other countries where cervical cancer screening is routine, this cancer is not so common.footnote 1

What causes cervical cancer?

Most cervical cancer
is caused by a virus called
human papillomavirus, or HPV. You can get HPV by
having
sexual contact with someone who has it. There are many
types of the HPV virus. Not all types of HPV cause cervical cancer. Some of
them cause
genital warts, but other types may not cause any
symptoms.

Most adults have been infected with HPV at some time. An infection may go away on its own. But sometimes it can cause genital warts or lead to cervical cancer. That's why it's important for women to have regular Pap tests. A Pap test can find
changes in cervical cells before they turn into cancer. If you treat these cell
changes, you may prevent cervical cancer.

What are the symptoms?

Abnormal cervical cell
changes rarely cause symptoms. But you may have symptoms if those cell changes
grow into cervical cancer. Symptoms of cervical cancer may include:

Bleeding from the vagina that is not normal, such as bleeding between menstrual periods, after sex, or after menopause.

Pain in the lower belly or pelvis.

Pain during
sex.

Vaginal discharge that isn't normal.

How is cervical cancer diagnosed?

As part of your
regular pelvic exam, you should have a Pap test. During a Pap test, the doctor
scrapes a small sample of cells from the surface of the cervix to look for cell
changes. If a Pap test shows abnormal cell changes, your doctor may do other
tests to look for precancerous or cancer cells on your cervix.

Your doctor may also do a Pap test and take a sample of tissue (biopsy) if you have symptoms of cervical cancer, such
as bleeding after sex.

Depending on how much the cancer has grown, you may have
one or more treatments. And you may have a combination of treatments. If you have a hysterectomy, you won't be able to have children. But a hysterectomy isn't always needed, especially when cancer is found very early.

Finding out that you have cancer can change your life. You may feel like your world has turned upside down and you have lost all control. Talking with family, friends, or a counselor can really help. Ask your doctor about support groups. Or call the American Cancer Society (1-800-227-2345) or visit its website at www.cancer.org.

Can cervical cancer be prevented?

The Pap test is
the best way to find cervical cell changes that can lead to cervical cancer.
Regular Pap tests almost always show these cell changes before they turn into
cancer. It's important to follow up with your doctor after any abnormal Pap
test result so you can treat abnormal cell changes. This may help prevent cervical
cancer.

If you are age 26 or younger, you can get the HPV vaccine, which protects against two types of HPV that cause most cases of cervical cancer.

The virus that causes
cervical cancer is spread through sexual contact. The best way to avoid getting
a
sexually transmitted infection is to not have
sex. If you do have sex, practice safer sex, such as
using condoms and limiting the number of sex partners you have.

Cause

Cervical cancer is caused by severe
abnormal changes in the cells of the
cervix. Most precancerous or cancerous cell changes
occur in the cervix at the
transformation zone, because these cells normally
undergo constant change. During this natural process of change, some cervical
cells can become abnormal if you are infected with high-risk types of HPV.

Other things
may play a role in causing cervical cancer, such as having more than one sex partner or smoking cigarettes.

Leakage of urine or stool
into the
vagina. This can happen when an abnormal opening (fistula) has developed between the vagina and the
bladder or rectum.

Weight loss.

What Happens

Cervical cancer happens when abnormal cells on the cervix grow out of control. Cervical cancer can often be successfully treated when it's found early. It is usually found at a very early stage through a Pap test.

If
cervical cancer isn't treated, it may spread from the
cervix to the vagina, and then into deeper tissue layers
of connective tissue around the uterus. As it progresses, it may spread to the
pelvic
lymph nodes and other pelvic organs.
Advanced-stage cancer may spread to lymph nodes; to
other organs in the pelvis, causing problems with kidney and bowel function; or
to other organs in the body, such as the liver and lungs.

Treatment of cervical cancer depends on the stage of your cancer and if it has spread.

What Increases Your Risk

A risk factor for cervical cancer is something that increases your chance of getting this cancer. Having one or more of these risk factors can make it more likely that you will get cervical cancer. But it doesn't mean that you will definitely get it. And many people who get cervical cancer don't have any of these risk factors.

High-risk sexual behaviors. These include having more
than one sex partner or having a sex partner who has more than one partner.
Safer sex can reduce your risk.

Having an
impaired immune system. Some conditions such as HIV can make you more likely to get an HPV infection.

Smoking cigarettes or breathing in secondhand smoke.

When To Call a Doctor

Call your doctor if you have:

Unexpected bleeding between menstrual
periods.

Menstrual periods that are irregular or 1½ to 2 times
longer than normal for 3 months in a row. For example, call if your periods usually last 6 days but have been lasting between 9 and 12 days for your last 3 periods.

Severe vaginal bleeding that causes you to soak 1 or 2 pads or tampons in 1 or 2 hours, or passing clots of blood from the vagina.

Unexpected bleeding after douching or sex.

Pain during sex.

Abnormal vaginal discharge containing mucus that may
be tinged with blood.

If you are diagnosed

If you have been diagnosed with
cervical cancer, be sure to follow your doctor's
instructions about calling when you have problems, new symptoms, or symptoms
that get worse.

Who to see

Health professionals who can evaluate your symptoms
and your risk factors, and who can diagnose cervical cancer include:

Exams and Tests

Early detection

The
Pap test is a routine screening test used to find
abnormal cell changes of the
cervix and to screen for
cervical cancer. Regular Pap test screening is the
most important tool in finding and treating cervical cell changes
before they progress to cervical cancer.

The recommended Pap test schedule is based on your age and things that increase your risk. Talk to your doctor about how often to have this test.

Diagnostic tests

If cervical cancer is suspected, your
doctor will ask about your
medical history and do a physical exam, including
a
pelvic exam and a Pap test.

Treatment Overview

Cervical cancer
found in its early stages can be successfully treated.
The choice of treatment and the
long-term outcome (prognosis) of
cervical cancer depend on the type and
stage of cancer. Your age, overall health, quality of
life, and desire to be able to have children must also be considered.

Types of treatment

Treatment choices for cervical cancer may be a single
therapy or a combination of therapies, such as:

Surgery to remove the cancer. The type of surgery needed depends on the
location and extent of cervical cancer and whether you want to have
children.

Radiation therapy, which uses high-dose X-rays or implants in the vaginal cavity to kill cancer cells. It is used for certain stages of cervical cancer. It is often used in combination with surgery.
To learn more, see Other Treatment.

Chemoradiation, which is a combination of chemotherapy and radiation. This is often used to treat both early-stage and late-stage cervical cancer.

Chemotherapy, which uses medicines to kill cancer cells. Chemotherapy may be used to treat advanced cervical cancer.

Additional information about cervical cancer is provided by the National Cancer Institute at www.cancer.gov/cancertopics/types/cervical.

Coping with emotions during treatment

When you first find out that you have cancer, you may feel scared or angry. Or you may feel very calm. It's normal to have a wide range of feelings and for those feelings to change quickly. Some people find that it helps to talk about their feelings with family and friends.

If your emotional reactions to cancer get in the way of your ability to make decisions about your health, it's important to talk with your doctor. Your cancer treatment center may offer psychological or financial services or both. And a local chapter of the American Cancer Society can help you find a support group.

Body image and sexual problems

Your feelings about your body and your sexuality may
change following treatment for cancer. Managing body image issues may involve talking openly with your
partner about your feelings and discussing your concerns with your doctor. Your
doctor may be able to refer you to organizations that can offer additional
support and information.

Treatment during pregnancy

Cancer treatment during pregnancy is the same as for nonpregnant women. But when you'll get treatment may depend on the stage of your cancer and what trimester you are in. For example, if you have early-stage cervical cancer and you are in your third trimester, your treatment may be delayed until after you deliver your baby. Treatment may cause problems such as an early
delivery or even the loss of the baby.

Follow-up care

After treatment for
cervical cancer, it is important to receive follow-up
care. Your oncologist or
gynecologic oncologist will schedule regular checkups
that will include:footnote 2

Cervical cancer that comes back

Cervical cancer
can return, or recur, after treatment. The chance that your
cancer will return depends on the stage of the initial cancer. Cancer found
early is less likely to come back than cancer found at a later stage.

Your long-term outcome (prognosis) for
recurrent cervical cancer depends greatly on how much
the cancer has spread when the recurrence is diagnosed.

Treatments include surgery and chemoradiation or chemotherapy to relieve symptoms. Your doctor may talk with you about being in a clinical trial. Clinical trials for cervical cancer are studying therapies that target cancer cells.

Palliative care

Palliative care is a kind of care for people who have a serious illness. It's different from care to cure your illness. Its goal is to improve your quality of life-not just in your body but also in your mind and spirit.
You can have this care along with treatment to cure your illness.

Palliative care providers will work to help control pain or side effects. They may help you decide what treatment you want or don't want. And they can help your loved ones understand how to support you.

End-of-life care

For some people who have advanced cancer, a time comes when treatment to cure the cancer no longer seems like a good choice. This can be because the side effects, time, and costs of treatment are greater than the promise of cure or relief. But you can still get treatment to make you as comfortable as possible during the time you have left. You and your doctor can decide when you may be ready for hospice care.

Get the HPV vaccine

If you are a woman age 26 or younger or a man age 21 and younger, get the HPV vaccine. The vaccines Cervarix(What is a PDF document?) and Gardasil(What is a PDF document?) protect against two types of human papillomavirus (HPV) that cause cervical cancer. It is recommended for children age 11 or 12, but can be given as early as age 9. For girls who have not already gotten the vaccine, it is recommended up to age 26. For boys who have not already gotten the shot, the vaccine is recommended up to age 21. Gardasil is used for males. Females can get either vaccine. For more information,
see the topic
Immunizations.

Reduce your risk of a sexually transmitted infection (STI)

Preventing an
STI, including HPV, is easier than treating an infection after it occurs. HPV infection usually doesn't cause symptoms, so
you or your partner may not know that you are infected.

To reduce your risk:

Talk with your partner about STIs before
beginning a sexual relationship. Find out if he or she is at risk for an STI.
Remember that it's possible to be infected with an STI without knowing
it. Some STIs, such as
HIV, can take up to 6 months before they are detected
in the blood.

Be responsible.

Avoid
sexual contact if you have symptoms of an STI or are
being treated for an STI.

Avoid all intimate sexual contact with
anyone who has symptoms of an STI or who may have been exposed to an
STI.

The fewer sex partners you have in your lifetime, the better it
is for your health. Your risk for an STI increases if you have several sex
partners or if your sex partner has more than one partner.

Use
male or
female condoms to reduce the risk of getting an STI.
Using male condoms when you have sex has been shown to reduce your risk of
getting HPV.footnote 4 Female condoms may help also, although
there has been less study of this type of protection.

Not having sexual contact is the only certain way to
prevent exposure to STIs. Sexually transmitted infections such as human
papillomavirus (HPV) can be spread to or from the genitals, anus, mouth, or
throat during sexual activities.

Home Treatment

The side effects of cancer treatment can be serious. Healthy habits such as eating a balanced diet and getting enough sleep and exercise may help control your symptoms. Your doctor may also give you medicines to help you with certain side effects.

Home treatment for nausea or vomiting includes watching
for and treating early signs of
dehydration. Signs include a dry mouth, sticky saliva, and
reduced urine output with dark yellow urine. Eating smaller meals may help. A little bit of ginger candy or ginger tea can help too.

Home treatment for diarrhea includes resting your stomach
and being alert for signs of dehydration. Check with your doctor before using
any nonprescription medicines for your diarrhea.

Home treatment for constipation includes making sure that you drink
enough fluids and include fruits, vegetables, and fiber in your diet each day.
Don't use a laxative without consulting your doctor.

Other symptoms that can be treated at home include:

Sleep problems. If you find that you have trouble sleeping, learn ways to manage sleep problems, such as having a sleep routine and making sure your bedroom is dark and quiet.

Fatigue. If you don't have any
energy and tire easily, try some
tips to help your fatigue. These include getting extra
rest, eating a balanced diet, and reducing your stress.

Urinary
problems, which can be caused by both cervical cancer and its treatment. It may
help to remove caffeinated drinks from your diet and to establish a schedule
of urinating every 3 to 4 hours, whether you feel the
need or not.

Hair loss. Hair loss may be unavoidable. But using
mild shampoos and avoiding damaging hair products will reduce irritation of
your scalp.

Stress.Managing stress may include expressing your feelings
to others. Learning relaxation techniques may also be helpful. Relaxation
techniques, such as meditation, and support groups may help too.

Pain. Not all forms of cancer treatment cause pain. But if you do have pain, there are many home treatments that can help.

Vaginal dryness. Lubricants, such as Astroglide or K-Y Jelly, may help. Or talk to your doctor about a low-dose vaginal estrogen cream, ring, or tablet.

Pain during sexual intercourse if your vagina was shortened during surgery. Changing positions may help make sex less painful. Talk with your doctor if you have any problems during sex that you think may be related to your surgery.

Surgery

Surgery to remove
the cancer depends on the
location and extent of cervical cancer and your desire to be able to have
children. You also may be given
radiation therapy,
chemotherapy, or a combination of the two (chemoradiation). These
treatments may be given before or after surgery to try to destroy any cancer
cells that may remain or to help control or shrink the tumor.

Surgery choices

Surgery for very early stages of cervical cancer may
preserve your ability to have children. Surgeries include:

Radical hysterectomy. This is surgery to remove the uterus, cervix, part of the vagina, and tissues around these organs. The ovaries, fallopian tubes, and nearby lymph nodes may also be removed.

Modified radical
hysterectomy. This is surgery to remove the the uterus, cervix, upper part of the vagina, and tissues around these organs. But less tissue and fewer organs are removed than in a radical hysterectomy.

Bilateral salpingo-oophorectomy (say "sal-PIN-go oh-uh-fuh-REK-tuh-mee"). This is surgery to remove both ovaries and both fallopian tubes.

Pelvic exenteration (say "ig-ZEN-tuh-ray-shun"). This is the most serious pelvic surgery. It is done when cancer has spread throughout the lower belly and pelvis. In this surgery, the uterus, cervix, vagina, ovaries, lower colon, rectum, and bladder are removed. Artificial openings are made so urine and stool can pass from the body into a collection bag. An artificial vagina can also be created during this surgery.

Dealing with side effects of surgery

Side effects from a conization or LEEP include mild cramping during the first few hours, soreness for several days, and vaginal discharge for about a week. These surgeries may be done in your doctor's office.

A hysterectomy is major surgery with general anesthesia, so you will likely be in the hospital for a few days. With laparoscopic surgery, you may go home the next day. As soon as you feel strong enough, get up and move around as much as you can. This helps prevent problems after surgery like blood clots, pneumonia, and gas pains.

Other side effects from hysterectomy include:

Pain or discomfort for a few days. Medicines can help with this, so talk with your doctor about pain medicines before your surgery.

Short-term effects, such as feeling sick to your stomach or having trouble emptying your bladder. These problems usually go away on their own after a few hours.

Early menopause, if you have not yet started menopause. You won't have menstrual periods any more. You may have hot flashes, vaginal dryness, night sweats, or other symptoms of menopause. Before your surgery, talk with your doctor about hormone therapy and other treatment options.

Changes in sexual response. For some women, having a hysterectomy changes their sexual response. If you notice any sexual problems, talk with your doctor.

Home treatment may help relieve some common after-surgery side effects.

Other Treatment

Radiation therapy

Radiation therapy is used for certain stages of
cervical cancer, often along with
surgery. Chemotherapy may be given at the same time as radiation treatment (chemoradiation) to improve survival rates. Chemoradiation may be used as the main treatment or after a hysterectomy.

Radiation therapy uses high-energy X-rays to
kill cancer cells and shrink tumors. Radiation may come from a machine outside
the body (external radiation therapy). Or it may come from radiation material
(radioisotopes) in thin plastic tubes inserted through the vagina into the
cervical area where the cancer cells are found.

Dealing with side effects of radiation

Radiation may cause many
side effects, including diarrhea and irritation of the bladder (radiation
cystitis). Home treatment may help relieve some common side effects of cancer treatment.

Your ability to have or enjoy sexual intercourse may also be
affected. This is because radiation may cause changes to the cells lining the vagina
(mucosa), making intercourse difficult or painful. A series of vaginal
dilators, starting with a small one and progressing to a larger size, may be
used after radiation therapy. Using the dilators can help by making the vaginal opening
larger.

Radiation to
treat cervical cancer may thin the bone and increase the risk of fractures in
the pelvic area, including hip fractures. You can take steps to prevent
thinning of the bone (osteoporosis), such as getting enough
calcium and vitamin D. Also, try to
prevent falls, which can lead to fractures. For more information, see the topic
Osteoporosis.

Clinical trials

Some women who have
cervical cancer may be interested in taking part in research studies called
clinical trials. Clinical trials are designed to find
better ways to treat cancer patients. They are based on the most up-to-date
information. Women who don't want standard treatments or are not cured using
standard treatments may want to take part in clinical trials. These are
ongoing in most parts of the United States and in some other countries for all
stages of cervical cancer.

Complementary therapy

People sometimes use complementary therapies along with medical treatment to help relieve symptoms and side effects of cancer treatments. Some of the therapies that may be helpful include:

Acupuncture. It can relieve pain and may help you deal with nausea and vomiting from chemotherapy.

Meditation or yoga. These mind-body treatments relieve stress. They may help you feel better and cope with treatment.

These mind-body treatments may help you feel better. They can make it easier to cope with treatment. They also may reduce chronic low back pain, joint pain, headaches, and pain from treatments.

Before you try a complementary therapy, talk to your doctor about the possible value and potential side effects. Let your doctor know if you are already using any of these therapies. They are not meant to take the place of standard medical treatment.

Other Places To Get Help

Organizations

American Cancer Society (ACS)

250 Williams Street NWAtlanta, GA 30303

www.cancer.org

National Cancer Institute (U.S.)

www.cancer.gov (or https://livehelp.cancer.gov/app/chat/chat_launch for live help online)

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